As children learn to walk, there are multiple possible deviations in their walking pattern that you may notice. Two of the more common gait deviations that we see as physical therapists are out toeing and in-toeing, also known as duck footed and pigeon toed, respectively.  

What is an Out-Toeing Gait Pattern?

If a child has an out toeing gait pattern, their feet will turn outwards while they walk. Out-toeing is sometimes referred to as “duck footed”. Out toeing or “duck footed” is the opposite of pigeon toe, which we explain below. There are multiple causes for out-toeing and most often are due to skeletal abnormalities, muscle imbalances, or is neurological in nature. Skeletal abnormalities may be outward rotation of the thigh bone in the hip joint (femoral retroversion) or outward rotation of the lower leg bone (external tibial torsion.) 

If a child has a neurological diagnosis or high/low muscle tone, this may lead to a flat foot position. Often, children with flat feet may also walk with an out toeing gait pattern. If there is an imbalance in muscle strength and length of the hip muscles, the tighter outer hip muscles may pull on the hip and rotate the hips outwards, especially if the muscles on the inside of the hips are weaker. 

What is an In-Toeing Gait Pattern?

Comparatively, if a child has an in-toeing gait pattern, their feet will turn inwards while they walk. In-toeing is sometimes referred to as “pigeon toed”, which is the opposite of duck toed. This gait pattern may also be caused by skeletal abnormalities, muscle imbalances, or is neurological in nature. If a child is in toeing, they may have inward rotation of the thigh bone in the hip joint (femoral anteversion) or inward rotation of the lower leg bone (internal tibial torsion.) 

Typically, higher muscle tone of the inner thigh muscles associated with neurological diagnoses causes an in-toeing pattern. The structure of your child’s foot may impact their gait, specifically if the inner portion of their foot appears to be concave and the outside of their foot appears convex (metatarsus adductus.) 

If there is an imbalance in muscle strength and length in the hip muscles, the tighter inner hip and thigh muscles may pull on the hip and rotate the hips inwards, especially if the muscles on the outside of the hips are weaker. Physical therapy can help to address these gait deviations. 

Below is a list of exercises you can practice at home with your child to work on building their strength and flexibility. 

Exercises to Address Out-Toeing (Duck-Footed)

• Squatting while holding a ball between the thighs

• To strengthen the hip muscles, have your child complete squats while holding a small ball between their thighs

• Walking on a balance beam, curb, or straight line

• In order for your child to practice improving his or her balance and adjust their foot position, have them practice walking on a balance beam, curb outside, or a line on the floor made with tape

• Modified single limb stance

• While standing on one foot with the other foot balanced on a step or a small ball, your child can practice building the strength of their feet and ankles while improving their single limb balance

• Duck walks

• Encourage your child to walk while rotating their hips and feet inwards like a duck

• Figure 4 stretch

• Have your child lay on his or her back. Cross one ankle over the opposite thigh and pull their leg in towards their chest to stretch the outer hip muscles

Exercises to Address In-Toeing (Pigeon-Toed)

Below are a few suggestions for pigeon toe exercises to try with your child.

• Soccer ball kicks with outward rotation of the hip

• Encourage your child to practice kicking a ball with the inside of their foot to work on rotating their hip outwards

• Penguin walks

• Encourage your child to walk while rotating their hips and feet outwards like a penguin

• Clamshells

• To strengthen your child’s outer hip muscles, have them lay on their side with their knees bent and legs stacked. Open the hip while keeping the ankles together (like a book)

• Fire hydrants

• While on hands and knees, have your child lift one leg and open up their hip outwards (like a dog on a fire hydrant!)

• Butterfly stretch

• To stretch the muscles of the inside of the thighs, have your child sit with their knees open and feet together

Noticing Your Child or Baby Out-Toeing or In-Toeing?

We hope you found this pigeon-toed vs. duck-footed overview helpful. If your child is walking with either of these gait deviations, especially if it is impacting his or her balance, safety, or ability to keep up with his or her peers, it may be necessary to schedule a pediatric physical therapy evaluation so a PT can customize a home exercise program specifically for your child. An individualized home exercise program will help you understand how to correct pigeon toe (in-toeing) or duck footed (out-toeing) gait patterns. 

Find Additional Resources in the NAPA Blog:

• Toe Walking in Children: What Parents Should Know
• Gross Motor Development for Infants and Toddlers
• 3 Tools to Help Your Child Who is on the Verge of Independent Walking
• 4 Gait Training Exercises By A Physical Therapist
• Serial Casting in Physical Therapy
• The 101 on W Sitting Position

About the Author 

Micayla Pedrick is a pediatric physical therapist at NAPA Center Boston. Micayla’s favorite springtime activity is growing fresh vegetables and herbs in her garden to cook with in new recipes. Her 3-year-old Husky, Theo, loves to keep her company while frolicking through the yard and gobbling up delicious zucchini, cucumbers, and tomatoes! 

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